Knot Formation at Removal of an Epidural Catheter Placed Against Insertion Resistance Encountered at the Entrance of the Epidural Space

Byung Tae Kil; Bong Il Kim; Jong Hae Kim

doi:10.7180/kmj.2016.31.2.184

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Kil, Kim, and Kim: Knot Formation at Removal of an Epidural Catheter Placed Against Insertion Resistance Encountered at the Entrance of the Epidural Space

Case Report

Kosin Medical Journal 2016;31(2):184-190.

Published online: 20 January 2016

DOI: https://doi.org/10.7180/kmj.2016.31.2.184

Knot Formation at Removal of an Epidural Catheter Placed Against Insertion Resistance Encountered at the Entrance of the Epidural Space

Byung Tae Kil, Bong Il Kim, Jong Hae Kim

Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea

Corresponding Author: Jong Hae Kim, Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea TEL: +82-53-650-4979 FAX: +82-53-650-4517 E-mail: usmed@cu.ac.kr

Received 13 August 20154 September 2015 Accepted 16 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Knotting of an epidural catheter occurs very rarely with an estimated incidence of 0.0015%. We present a case of an epidural catheter knot formed at removal of an epidural catheter following a forceful insertion of the catheter against resistance met at the entrance of the epidural space during threading of the catheter through Tuohy needle placed uneventfully in a 65 year-old male patient undergoing epidural anesthesia. During removal of the epidural catheter, significant resistance was encountered on traction and it was found that approximately 1.5 ㎝ portion of the catheter had been retained within the patient's subcutaneous tissue. Firm traction was employed to withdraw the catheter against the resistance. The catheter was pulled out uneventfully from the patient. A knot estimated to be formed during removal of the catheter was observed at 0.6 ㎝ proximal to the catheter tip. No complications and side effects were noted until the patient's discharge.

Keywords: Catheters, Epidural anesthesia, Postoperative complications, Traction

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Fig. 1.

A knot of the epidural catheter is observed at 0.6 cm proximal to the catheter tip (red circle).

Fig. 2.

The magnified view of the knot under a light microscope shows a reduced diameter of the epidural catheter proximal to the knot due to a significant tension against resistance encountered during removal of the catheter and a small amount of blood presumably from an epidural vein injured from forceful placement of the epidural catheter despite resistance upon insertion of the catheter into the epidural space.

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